Use of this form complies with the Western Australian Governements Concessions for Classics Application Form E116. All conditions must be adhered to.

When blank, this form is classed as OFFICIAL, when completed, this form is classed as OFFICIAL SENSITIVE

To be eligible for the Concessions for Classics scheme: The vehicle licence holder must:

• Be a current financial member of a Department of Transport (DoT) approved motoring club or association; and
• Provide proof of vehicle ownership.

• Motoring clubs are eligible for the Concession for Classics scheme on vehicles licensed in the Club’s name as long as the club is a legal entity as defined below:
• A corporate body;
• An incorporated body; or
• Any other organisation that is recognised as being a legal entity.

• Be manufactured prior to 1990; or
• Be a street rod which has a body and frame that were built before 1949; or a replica of a vehicle the body and frame of which were built before 1949; and
• Be a light vehicle with a GVM not exceeding 4,500 kg.

089	Vehicle used for club events or purposes approved by the CEO DoT. An approved plate or label must be affixed above or below the vehicle number plate identifying the vehicle for limited road use.
369	To be in receipt of this concession the owner must be a financial member of an approved motoring club, or be a DoT approved motoring club or association.
370	This vehicle licence cannot be transferred, please contact Concessions Section.

NOTE: If the vehicle is used for purposes that breach the conditions under which the concession is granted, the vehicle will be deemed unlicensed. In these circumstances your motor vehicle injury insurance will generally not cover you against claims for personal or fatal injury caused to another person.

• I declare that:
• The information provided on this application is true and correct.
• I am a financial member of a DoT approved motoring club or association.
• The use of the vehicle detailed on this application shall be in accordance with the conditions of the Concessions for Classics scheme and must not exceed 90 days of vehicle use per calendar year as follows:
  • 60 days of club use for participation in club sanctioned events; and
  • 30 days for personal use, maintenance, repair or testing.

• I will notify DoT within 14 days should I cease to be a financial member of an approved motoring club.
• I will record all vehicle use prior to undertaking any journey.
• I understand that under the Road Traffic (Administration) Act 2008, it is an offence to provide false or misleading information.

I, being an authorised officer of the club named below, certify that the applicant is a current financial member of the club in relation to the vehicle detailed.